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Objective Methods Results Conclusion Lower limb discrepancy (LLD) was frequently observed in patients with idiopathic scoliosis (IS), potentially associated with etiopathogenesis. Although sole lifts had been proposed as a conservative treatment for IS, evidence supporting their efficacy was limited. This study aimed to assess the effects of sole lift intervention on pediatric patients with mild IS, specifically focusing on thoracolumbar/lumbar (TL/L) curvature.Twenty patients, with an average age of 12.3 ± 3.1 years and presenting mild TL/L curve (15.6° ± 6.2°), were selected from a pool of 267 pediatric IS patients in the outpatient of our spine center from February 2023 to August 2023. Inclusion criteria comprised a main TL/L curve ranging between 10° and 40°, the lower limb positioned at the convexity of the main curve, and LLD of less than 2 cm; individuals requiring bracing or surgical intervention were excluded. Custom sole lifts were used to address the shorter lower limb with the objective of leveling the pelvis. Radiographic evaluations were conducted both before and after intervention using standing full spine posteroanterior radiographs and full leg length radiographs. Statistical analysis was undertaken to evaluate curve correction and its associations with other influencing factors.The mean structural and functional LLD were 7.1 ± 4.5 mm and 7.1 ± 4.1 mm, respectively. Among the 20 patients, four exhibited structural LLD greater than 10 mm. The average follow‐up duration was 6.4 ± 1.9 months (range: 3–8 months). Following sole lift intervention (7.0 ± 3.0 mm), a significant reduction was observed in the TL/L curve compared to the pre‐sole lifting measurements (15.6° ± 6.2° vs. 12.1° ± 7.2°, p < 0.001), as well as a notable decrease in the thoracic curve (12.2° ± 4.0° vs. 8.6° ± 6.3°, p = 0.064). Nine patients experienced a significant curve reduction of ≥5°, while eight showed a reduction between 0° and 5°; however, two patients exhibited no change in curve magnitude. Furthermore, the correction rate of the TL/L curve correlated significantly with functional LLD (r = −0.484, p = 0.030) and pelvic obliquity (r = −0.556, p = 0.011), highlighting the active pelvic compensation in maintaining balance between the spine and lower limbs. Conversely, no significant correlation was observed between curve correction and structural LLD (p > 0.05). Additionally, even after adjusting for other influencing factors, the TL/L Cobb angle remained significantly different between pre‐ and post‐sole lifting (p = 0.037).This study confirmed the effectiveness of sole lift intervention in correcting TL/L and thoracic curves among the mild IS children with a main TL/L curve, providing a supplementary conservative treatment option for patients with the lower limb at the convexity of the main curve. Moreover, our findings underscored the active compensation of the lower limbs and the pelvis in the etiopathogenesis of IS, highlighting the importance of considering their influence in treatment strategies. [ABSTRACT FROM AUTHOR]

Simple Summary: Proton therapy has been shown to provide dosimetric benefits in comparison with IMRT when treating prostate cancer with whole pelvis radiation; however, the optimal proton beam arrangement has yet to be established. Twenty-three post-prostatectomy patients were planned using three different beam arrangements: two-field (opposed laterals), three-field (opposed laterals inferiorly matched to a posterior–anterior beam superiorly), and four-field (opposed laterals inferiorly matched to two posterior oblique beams superiorly) arrangements. CTV coverages were similar for all plans, while the four-field plan provided the lowest doses to several metrics for bladder, bowel, sigmoid, rectum, femoral head, bone, penile bulb, and skin. The data presented herein may help inform the future delivery of whole pelvis IMPT for prostate cancer. Background and purpose: Proton therapy has been shown to provide dosimetric benefits in comparison with IMRT when treating prostate cancer with whole pelvis radiation; however, the optimal proton beam arrangement has yet to be established. The aim of this study was to evaluate three different intensity-modulated proton therapy (IMPT) beam arrangements when treating the prostate bed and pelvis in the postoperative setting. Materials and Methods: Twenty-three post-prostatectomy patients were planned using three different beam arrangements: two-field (IMPT2B) (opposed laterals), three-field (IMPT3B) (opposed laterals inferiorly matched to a posterior–anterior beam superiorly), and four-field (IMPT4B) (opposed laterals inferiorly matched to two posterior oblique beams superiorly) arrangements. The prescription was 50 Gy radiobiological equivalent (GyE) to the pelvis and 70 GyE to the prostate bed. Comparisons were made using paired two-sided Wilcoxon signed-rank tests. Results: CTV coverages were met for all IMPT plans, with 99% of CTVs receiving ≥ 100% of prescription doses. All organ at risk (OAR) objectives were met with IMPT3B and IMPT4B plans, while several rectum objectives were exceeded by IMPT2B plans. IMPT4B provided the lowest doses to OARs for the majority of analyzed outcomes, with significantly lower doses than IMPT2B +/− IMPT3B for bladder V30–V50 and mean dose; bowel V15–V45 and mean dose; sigmoid maximum dose; rectum V40–V72.1, maximum dose, and mean dose; femoral head V37–40 and maximum dose; bone V40 and mean dose; penile bulb mean dose; and skin maximum dose. Conclusion: This study is the first to compare proton beam arrangements when treating the prostate bed and pelvis. four-field plans provided better sparing of the bladder, bowel, and rectum than 2- and three-field plans. The data presented herein may help inform the future delivery of whole pelvis IMPT for prostate cancer. [ABSTRACT FROM AUTHOR]

This study aims to describe the characteristics of patients with a pelvic fracture treated at a level 1 trauma center, the proportion of prehospital undertriage and the use of pelvic circumferential compression device (PCCD). This is a retrospective cohort study. Prehospital and inhospital medical records of adults (≥16 y old) with a pelvic fracture who were treated at Hopital de l'Enfant-Jesus–CHU de Québec (Quebec City, Canada), a university-affiliated level 1 trauma center, between September 01, 2017 and September 01, 2021 were reviewed. Isolated hip or pubic ramus fracture were excluded. Data are presented using proportions and means with standard deviations. A total of 228 patients were included (males: 62.3%; mean age: 54.6 [standard deviation 21.1]). Motor vehicle collision (47.4%) was the main mechanism of injury followed by high-level fall (21.5%). Approximately a third (34.2%) needed at least one blood transfusion. Compared to those admitted directly, transferred patients were more likely to be male (73.0% versus 51.3%, P < 0.001) and to have a surgical procedure performed at the trauma center (71.3% versus 46.9%, P < 0.001). The proportion of prehospital undertriage was 22.6%. Overall, 17.1% had an open-book fracture and would have potentially benefited from a prehospital PCCD. Forty-six transferred patients had a PCCD applied at the referral hospital of which 26.1% needed adjustment. Pelvic fractures are challenging to identify in the prehospital environment and are associated with a high undertriage of 22.6%. Reducing undertriage and optimizing the use of PCCD are key opportunities to improve care of patients with a pelvic fracture. • Of all patients with a pelvic fracture, 39 (17.1%) patients had an open-book fracture and could have beneficiated from a pelvic circumferential compression device (PCCD). • Prehospital triage was suboptimal and remains a challenge. The proportion of undertriage was 22.6%. • PCCDs are complex to install. A quarter of the PCCDs installed before transfer needed to be repositioned. [ABSTRACT FROM AUTHOR]

Background: Ewing's sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60–70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing's sarcoma has the unique problem of leading to high rates of postoperative infection. Case presentation: We present the case of a Japanese 14-year-old boy with left iliac Ewing's sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis. Conclusion: Our case highlights the successful management of a left iliac Ewing's sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases. [ABSTRACT FROM AUTHOR]

Background: Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. Case presentation: We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. Conclusions: Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere. [ABSTRACT FROM AUTHOR]

Abstract Background Ewing’s sarcoma is a primary bone tumor predominantly observed in children and adolescents, necessitating a multidisciplinary treatment approach. While localized cases have a 5-year survival rate of 60–70%, the prognosis is significantly worse in pelvic advanced cases with metastasis. Moreover, pelvic Ewing’s sarcoma has the unique problem of leading to high rates of postoperative infection. Case presentation We present the case of a Japanese 14-year-old boy with left iliac Ewing’s sarcoma and multiple metastases. At the initial visit, imaging revealed a large tumor in the left iliac bone with extraosseous extension and metastasis to multiple sites. Neoadjuvant chemotherapy resulted in significant tumor reduction. Surgical resection was performed without pelvic ring reconstruction to enable early postoperative chemotherapy and minimize postoperative infection risk. Despite complete abductor muscle removal, the patient achieved a stable gait postoperatively by centering the load axis. Conclusion Our case highlights the successful management of a left iliac Ewing’s sarcoma with multiple metastases, with a focus on functional preservation and infection risk reduction. Pelvic ring reconstruction was not performed to avoid postoperative complications, emphasizing the importance of early postoperative chemotherapy. The patient achieved a stable gait postoperatively, demonstrating the potential benefits of this approach in similar cases.

Abstract Background Schwannomas are benign usually encapsulated nerve sheath tumors derived from the Schwann cells, and affecting single or multiple nerves. The tumors commonly arise from the cranial nerves as acoustic neurinomas but they are extremely rare in the pelvis and the retroperitoneal area. Retroperitoneal pelvic schwannomas often present with non-specific symptoms leading to misdiagnosis and prolonged morbidity. Case presentation We report the case of a 59-year-old woman presenting with a feeling of heaviness in the lower abdomen who was found to have a retroperitoneal pelvic schwannoma originating from the right femoral nerve. She had a history of two resections of peripheral schwannomas at four different sites of limbs. After conducting magnetic resonance imaging, this pelvic schwannoma was misdiagnosed as a gynecological malignancy. The tumor was successfully removed by laparoscopic surgery. Pathological analysis of the mass revealed a benign schwannoma of the femoral nerve sheath with demonstrating strong, diffuse positivity for S-100 protein. Conclusions Although retroperitoneal pelvic schwannoma is rare, it should be considered in the differential diagnosis of pelvic masses, especially in patients with a history of neurogenic mass or the presence of neurogenic mass elsewhere.

BackgroundLasers and energy-based technologies have been developed for genitourinary applications over the past several decades.AimsThis consensus article aims to categorize the published articles and clinical trial data that culminated in protocol development of technology for genitourinary applications, and to develop consistent parameters in future clinical trials.Materials and methodsThe published articles and clinical trials data on lasers and energy-based devices applied to genitourinary conditions were categorized according to device and condition and consensus developed on protocols and parameters.ResultsThe devices in genitourinary applications were classified as fractional lasers, radiofrequency and high-intensity focused electromagnetic field therapy. The consensus of the protocols and parameters based upon the published clinical trials of their application to the vaginal and urologic conditions associated with genitourinary syndrome of menopause was developed and organized according to device and condition.DiscussionThe status of FDA clearances and future pathways are discussed.ConclusionsThis consensus article categorizes and presents the protocols and practices for the main classes of lasers and energy-based devices for genitourinary applications in future clinical trials.

Abstract Background and objectives It is known that difficulty sleeping after a fracture can have negative effects on both mental and physical health and may prolong the recovery process. The objective of this study is to explore how sleep quality and psychological health are linked in patients with pelvic and acetabulum fractures. Methods A study was conducted on 265 patients between 2018 and 2022 who had suffered pelvic and acetabulum fractures. The study examined various factors, including age, gender, cause of injury, post-operative complications, and injury severity. The study employed ordinal logistic regression to examine the relationship between various pelvic fractures and seven subscales of the Majeed Pelvic Score (MPS), as well as the Sleep Disorder Questionnaire (SDQ) and Beck Depression Inventory (BDI). The study focused on the postoperative outcome one year after surgery, and each patient was assessed at the one-year mark after surgical intervention. Additionally, the study evaluated the functional outcome, sleep quality, and psychological disorders of the patients. Results From 2018 to 2022, a total of 216 patients suffered from pelvic and acetabulum fractures. Among them, 6.6% experienced borderline clinical depression, and 45.2% reported mild mood disturbances. Anxiety was found to be mild to moderate in 46% of Tile C and posterior acetabulum wall fracture patients. About 24.8% of patients reported insomnia, while 23.1% reported sleep movement disorders. However, no significant correlation was found between fracture types and sleep disorders. The mean Majeed pelvic score (MPS) was 89.68. Conclusions Patients with pelvic and acetabular fractures typically experience functional improvement, but may also be at increased risk for insomnia and sleep movement disorders, particularly for certain types of fractures. Psychological well-being varies between fracture groups, with signs of borderline clinical depression observed in some cases. However, anxiety levels do not appear to be significantly correlated with pelvic and acetabular fractures.

Bone image analysis and categorizing bone cancers have both seen advancements thanks to deep learning (DL), more notably convolution neural networks (CNN). This study suggests a brand-new CNN-based methodology for categorizing pelvic bone tumors specifically. This work aims to create a pelvic bone computed tomography (CT) image categorization system based on deep learning. The proposed technique uses a convolutional neural network (CNN) architecture to automatically extract information from the CT images and classify them into distinct categories of tumors. A total of 178 3D CT pictures was discovered and added retroactively. DenseNet created the image-based model with Adam optimizer and cross entropy loss. The suggested system's accuracy is assessed using a variety of performance indicators, including sensitivity, specificity, and F1-score. As demonstrated by the experiment findings, the suggested deep learning based classification system has a high degree of accuracy (94%), making it useful for the diagnosis and treatment of pelvic bone tumors. Our promising results might hasten the use of DL-assisted CT diagnosis for pelvic bone tumors in the future. [ABSTRACT FROM AUTHOR]

Background Aims Materials and Methods Results Conclusions Dysmenorrhoea‐Related Pelvic Pain (DRPP) is a common condition, which may or may not include bladder‐related symptoms. Primary health care practitioners (PHCP) rely heavily on language for diagnosis of DRPP‐related conditions. However, there are no established pain descriptors to assist PHCP to determine whether an individual's DRPP may include a bladder component.To identify differences in the use of pain descriptors in women with DRPP with and without a co‐existing bladder pain component, through an exploratory study of the language of pelvic pain in women.A cross‐sectional online survey of Australian and New Zealand women (n = 750, ages 18–49) who have self‐identified pelvic pain. Free text and predetermined pain descriptors used by women with a self‐perceived bladder pain component (DRPPB+, n = 468) were compared to those without bladder pain (DRPPB−, n = 282). Statistical analysis included Pearson χ2, logistic regression and analysis of variance tests using StataCorp Stata Statistical Software combined with qualitative data from AntConc concordance software.Within free‐form text, bloating (P = 0.014) and pressure (P = 0.031) were used more commonly to describe dysmenorrhoea in women with DRPPB+, while the word excruciating (P < 0.001) was more commonly used by women with DRPPB−. From a pre‐determined list of descriptors, pounding (P < 0.001), tingling (P < 0.001), stabbing (P = 0.010), burning (P = 0.002) and cramping (P = 0.021) were more commonly used by women with DRPPB+, than women with DRPPB−.Systematic patterns of word use should encourage practitioners to further enquire about bladder symptoms that may co‐exist with dysmenorrhoea. Knowledge of these words may be useful in targeting diagnostic and therapeutic interventions. [ABSTRACT FROM AUTHOR]

Introduction: External beam radiation therapy (EBRT) has known effects on bone health. No large database studies have looked at the effects of pelvic EBRT on total hip arthroplasty (THA) outcomes. The purpose of this study was to evaluate 90-day and long-term (>2 years) complication rates following THA in patients with a history of pelvic malignancy and EBRT. Methods: Patients were retrospectively identified using a national insurance claims database. Subjects who underwent THA for osteoarthritis or avascular necrosis were included if they had at least 2-year follow-up and were stratified into 3 cohorts: (1) prior pelvic malignancy diagnosis (prostate, cervical, uterine, ovarian, or rectal) and EBRT (Group A); (2) prior malignancy diagnosis but no EBRT (Group B); and (3) neither prior malignancy diagnosis nor EBRT (Group C). Univariate and multivariate analyses were conducted to evaluate for an association between prior EBRT and the incidence of 90-day and 2-year complication rates using chi-square, student t -tests, and logistic regression analyses where appropriate. Results: 671,554 patients met the inclusion criteria. Group A had higher odds of all-cause revision, septic revision, and loosening with revision after 2 years when compared to Group C and Group B (p < 0.001). Group A subjects had higher rates of 90-day deep vein thrombosis, sepsis, and stroke (p < 0.001) than groups B and C. Conclusions: Prior EBRT for pelvic malignancy was associated with significantly increased rates of all-cause revision, septic revision, and loosening as well as 90-day medical complications. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic organ prolapse (POP) is an important health problem but it is still receiving little attention, patients often seek medical help only when the disease is very disturbing/severe. Case description: This case report describes a series of three cases of POP in young women who had similar profiles in terms of several characteristics, including age, occupation, ethnicity, BMI, parity, age of the youngest child (years), number of vaginal deliveries, operative vaginal deliveries, episiotomy, birth weight of the largest child, family history of prolapse, diagnosis, and procedures performed. In this case series, conservative operative treatment (Purandare hysteropexy) was carried out, then an examination of the sacrouterine ligament tissue was performed from the operation. The results of the examination showed a decrease in the expression of type I collagen, an increase in type III collagen, an increase in the levels of matrix metalloproteinases-2 (MMP-2), and MMP-9 which based on previous studies are found in patients with POP. Conclusion: Conservative treatment with Purandare hysteropexy was done in all cases, further research is needed to establish whether this condition is the cause of the occurrence of POP in young people and the genetic correlation associated with the disorder. [ABSTRACT FROM AUTHOR]

This study presents the case of a 40-year-old male patient after renal transplantation. The CT scan revealed a large mass in the lower abdomen and pelvis, with a branch of the right external iliac artery intersecting the growth. After a comprehensive examination, it was shown that the mass originated from the transplanted kidney, and a radical nephrectomy (including the mass) was performed. We document a case of atypical angiomyolipoma (AAM) occurring in a transplanted kidney. This article reports the case study and a brief literature review of the clinical presentation, diagnosis and treatment of AAM.

Ileus and pseudo-obstruction are clinical syndromes that are among the most common postoperative complications. Identifying an effective treatment approach for these conditions is essential. Therefore, the aim of this study is to investigate the effect of Dimethicone on preventing ileus in patients with pelvic and femoral fractures.This study was conducted on 120 patients, with 60 individuals in the Dimethicone group and 60 individuals in the control group. After recording demographic information and clinical notes, bowel movements and defecation after surgery were also recorded. The statistical tests of Chi-square, Fisher's exact-test, Mann-Whitney, and independent t-test were utilized to compare the data.The primary outcome of the study determined the incidence of ileus in the intervention and control groups (intervention group = 1.7 % and control group = 3.3 %) (P = 0.99). The secondary outcome involved comparing the time of gas expulsion between the two groups, intervention, and control (intervention group = 21.05 h and control group = 22.03 h) (P = 0.065). Although the time of gas and feces expulsion, as well as the initiation of bowel movements and the occurrence of ileus, were lower in the intervention group, there was no statistically significant difference in the postoperative results, particularly regarding the occurrence of ileus and the reduction in the duration of feces and gas expulsion and the initiation of bowel movements in patients receiving Dimethicone compared to the control group.Considering the lack of statistical significance in the obtained results and the absence of similar studies using Dimethicone, further research and larger sample size studies with Dimethicone or other pharmacological methods are needed to find the most effective treatment approach in reducing the occurrence of ileus after surgery.

Urinary incontinence affects up to a quarter of the female population at an active age of over 40 years old. The rate increases by 40% for females over 60 years old. Medical rehabili-tation regarding stress, urge or mixed geriatric urinary incontinence pathologies by using physical, noninvasive methods is poorly reported in literature, even though the obtained results are quantifiable, consistent, durable through continuous and periodic exercise. The objectives of rehabilitation of stress urinary incontinence, urge incontinence and mixed stress and urge urinary incontinence are the conscious toning of muscles of the pelvic floor, patient's awareness of contractions thereof, and the improvement of these patients' quality of life. Toning the muscles of the pelvic floor is essential in stress urinary incontinence whereas in urge incontinence it may increase urination control. Physical exercises increase the muscle tonus of the pubococcygeus muscles surrounding the vagina and the anus, and whose contraction may stop the evacuated quantity of urine, faeces and gases. The first-line treatment is the Kegel perineal reeducation, with a preventive and curative role in the treatment of urinary incontinence, also during the first and second stage of genital pro-lapse. Reeducation, supervision, guidance, relaxation, and exercise are essential elements in the reduction of urinary incontinence or prolapse in nascent stages. In literature and in practice there are several approaches to pelvic rehabilitation: some are minimally invasive, while others are non-invasive. In the current investigation, a group of elderly patients with stress, neurological or/and mixed urinary incontinence--which was linked to a mild genital prolapse in the female patients--were treated with four minimally invasive and non-invasive techniques. Associated comorbidities were type II diabetes (ADO treated) and a previous ischemic stroke in antecedents. Kegel exercises will be supplemented by transcutaneous electrical neurostimulation. Electrical neurostimulation also brings non painful electrical stimulation thus producing the contraction of the external sphincter muscle of urethra and the levator ani muscle inducing the inhibition of the detrusor mus-cle and of the contraction of the urinary bladder. After a 3-4 week training, subjective improvements and the spacing out of urinations to 3-4 hours are registered. The continuation of treatment up to 2 months (60 days) additionaly improves patients' functional status, thus substantiating and stabilizing the obtained results over time. Positive outcomes were attained, as the patient was able to effectively complete the pelvic rehabilitation course of action. Urinary losses could be completely eliminated and the number of nighttime bath-room visits was lowered to the recommended physiological threshold (one awakening per night). [ABSTRACT FROM AUTHOR]

With advancements in cancer treatment, the survival rates for many malignancies have increased. However, both the primary tumors and the treatments themselves can give rise to various complications. Acute symptoms in oncology patients require prompt attention. Abdominopelvic oncologic emergencies can be classified into four distinct categories: vascular, bowel, hepatopancreatobiliary, and bone-related complications. Radiologists need to be familiar with these complications to ensure timely diagnosis, which ultimately enhances patient outcomes. [ABSTRACT FROM AUTHOR]

Introduction: Trauma to the pelvic ring and associated haemorrhage represent a management challenge for the multidisciplinary trauma team. In up to 10% of patients, bleeding can be the result of an arterial injury and mortality is reported as high as 89% in this cohort. We aimed to assess the mortality rate after pelvic trauma embolisation and whether earlier embolisation improved mortality. Methods: Retrospective study at single tertiary trauma and referral centre, between 1 January 2009 and 30 June 2022. All adult patients who received embolisation following pelvic trauma were included. Patients were excluded if angiography was performed but no embolisation performed. Results: During the 13.5‐year time period, 175 patients underwent angiography and 28 were excluded, leaving 147 patients in the study. The all‐cause mortality rate at 30‐days was 11.6% (17 patients). The median time from injury to embolisation was 6.3 h (range 2.8–418.4). On regression analysis, time from injury to embolisation was not associated with mortality (OR 1.01, 95% CI 0.952–1.061). Increasing age (OR 1.20, 95% CI 1.084–1.333) and increasing injury severity score (OR 1.14, 95% CI 1.049–1.247) were positively associated with all‐cause 30‐day mortality, while non‐selective embolisation (OR 0.11, 95% CI 0.013–0.893) was negatively associated. Conclusion: The all‐cause mortality rate at 30‐days in or cohort was very low. In addition, earlier time from injury to embolisation was not positively associated with all‐cause 30‐day mortality. Nevertheless, minimising this remains a fundamental principle of the management of bleeding in pelvic trauma. [ABSTRACT FROM AUTHOR]

Sex differences in visceral nociception have been reported in clinical and preclinical studies, but the potential differences in sensory neural encoding of the colorectum between males and females are not well understood. In this study, we systematically assessed sex differences in colorectal neural encoding by conducting high-throughput optical recordings in intact dorsal root ganglia (DRGs) from control and visceral hypersensitive mice. We found an apparent sex difference in zymosan-induced behavioral visceral hypersensitivity: enhanced visceromotor responses to colorectal distension were observed only in male mice, not in female mice. In addition, a higher number of mechanosensitive colorectal afferents were identified per mouse in the zymosantreated male group than in the saline-treated male group, whereas the mechanosensitive afferents identified per mouse were comparable between the zymosan- and saline-treated female groups. The increased number of identified afferents in zymosantreated male mice was predominantly from thoracolumbar (TL) innervation, which agrees with the significant increase in the TL afferent proportion in the zymosan group as compared with the control group in male mice. In contrast, female mice showed no difference in the proportion of colorectal neurons between saline- and zymosan-treated groups. Our results revealed a significant sex difference in colorectal afferent innervation and sensitization in the context of behavioral visceral hypersensitivity, which could drive differential clinical symptoms in male and female patients. NEW & NOTEWORTHY We used high-throughput GCaMP6f recordings to study 2,275 mechanosensitive colorectal afferents in mice. Our results revealed significant sex differences in the zymosan-induced behavioral visceral hypersensitivity, which were present in male but not female mice. Male mice also showed sensitization of colorectal afferents in the thoracolumbar pathway, whereas female mice did not. These findings highlight sex differences in sensory neural anatomy and function of the colorectum, with implications for sex-specific therapies for treating visceral pain. [ABSTRACT FROM AUTHOR]

To determine the utility of routine postoperative vaginal cuff examination for detection of vaginal cuff dehiscence (VCD) after total laparoscopic hysterectomy (TLH). Retrospective cohort study. Quaternary care academic hospital in the United States. All patients who underwent TLH with a minimally invasive gynecologic surgeon at our institution from 2016 to 2022. Laparoscopic hysterectomy with routine vaginal cuff check 6 to 8 weeks postoperatively and laparoscopic hysterectomy without routine vaginal cuff check. We identified 703 patients who underwent TLH, 216 (30.7%) with routine cuff checks and 487 (69.3%) without. Within the no cuff check group, 287 (58.9%) had entirely virtual follow-up. There was no difference in VCD between the routine cuff check (1.28%, n = 2) and no cuff check groups (0.93%, n = 7, p =.73). Median time to VCD was 70.0 days (27.5–114.0). No VCDs were identified in asymptomatic patients on routine examination, and both patients in the cuff check group with VCD had appropriately healing cuffs on routine examination. In the cuff check group, 7 patients (3.2%) had findings of incomplete healing requiring intervention (silver nitrate, extended pelvic rest), all of whom were asymptomatic at the time of examination. Eight patients (3.7%) in the routine cuff check group and 21 (4.3%) in the no examination group required a nonroutine cuff check owing to symptoms. There was no difference in points of contact for postoperative symptoms between the groups (median 0 [0–1.0] for both groups, p =.778). Routine postoperative vaginal cuff examination does not seem to affect or negate the risk of future VCD. Virtual follow-up for asymptomatic patients may be appropriate after TLH. [ABSTRACT FROM AUTHOR]

Introduction: Pelvic ring fractures categorized under Tile Categories B and C denote partially and fully unstable fractures, respectively. This study aimed to identify the clinically associated factors of Tile B/C pelvic ring fractures. Methods: This retrospective cross-sectional study reviewed medical records from the Emergency Medicine department at Ramathibodi Hospital in Bangkok, Thailand. The study included individuals aged ≥ 15 who experienced accidents from 2012 to 2021. To investigate the associations between the clinical variables and three critical outcomes, including Tile B/C pelvic ring fractures, major vascular injuries, and the necessity for surgical or radiological interventions, multivariable logistic regression analysis was employed. Results: A total of 198 patients were included in the study, among whom 34.8% were diagnosed with Tile B/C pelvic ring fractures. The analysis revealed several significant predictors of Tile B/C fractures, including the presence of pelvic tenderness (adjusted odds ratio [aOR] = 15.25, 95% confidence interval [CI] = 5.86-39.66, p < 0.001), and a shock index (SI) ≥1 (aOR = 4.2, 95% CI = 1.24-14.22, p = 0.021). Moreover, Tile B/C pelvic ring fractures were associated with an increased incidence of major vascular events and the imperative requirement for surgical or radiological interventions. Conclusion: Clinical findings of pelvic tenderness and an SI ≥1 are strong predictive clinical factors associated with Tile B/C pelvic fractures. Early diagnosis, application of an pelvic binder, provision of initial resuscitation, and prompt transportation to a definitive care facility are crucial components of management.

PURPOSE: To evaluate interobserver agreement in assigning imaging features and classifying adnexal masses using the IOTA simple rules versus O-RADS lexicon and identify causes of discrepancy. METHODS: Pelvic ultrasound (US) examinations in 114 women with 118 adnexal masses were evaluated by eight radiologists blinded to the final diagnosis (4 attendings and 4 fellows) using IOTA simple rules and O-RADS lexicon. Each feature category was analyzed for interobserver agreement using intraclass correlation coefficient (ICC) for ordinal variables and free marginal kappa for nominal variables. The two-tailed significance level (a) was set at 0.05. RESULTS: For IOTA simple rules, interobserver agreement was almost perfect for three malignant lesion categories (M2-4) and substantial for the remaining two (M1, M5) with k-values of 0.80-0.82 and 0.68-0.69, respectively. Interobserver agreement was almost perfect for two benign feature categories (B2, B3), substantial for two (B4, B5) and moderate for one (B1) with k-values of 0.81-0.90, 0.69-0.70 and 0.60, respectively. For O-RADS, interobserver agreement was almost perfect for two out of ten feature categories (ascites and peritoneal nodules) with k-values of 0.89 and 0.97. Interobserver agreement ranged from fair to substantial for the remaining eight feature categories with k-values of 0.39-0.61. Fellows and attendings had ICC values of 0.725 and 0.517, respectively. CONCLUSION: O-RADS had variable interobserver agreement with overall good agreement. IOTA simple rules had more uniform interobserver agreement with overall excellent agreement. Greater reader experience did not improve interobserver agreement with O-RADS.

Background and purpose: Proton therapy has been shown to provide dosimetric benefits in comparison with IMRT when treating prostate cancer with whole pelvis radiation; however, the optimal proton beam arrangement has yet to be established. The aim of this study was to evaluate three different intensity-modulated proton therapy (IMPT) beam arrangements when treating the prostate bed and pelvis in the postoperative setting. Materials and Methods: Twenty-three post-prostatectomy patients were planned using three different beam arrangements: two-field (IMPT2B) (opposed laterals), three-field (IMPT3B) (opposed laterals inferiorly matched to a posterior–anterior beam superiorly), and four-field (IMPT4B) (opposed laterals inferiorly matched to two posterior oblique beams superiorly) arrangements. The prescription was 50 Gy radiobiological equivalent (GyE) to the pelvis and 70 GyE to the prostate bed. Comparisons were made using paired two-sided Wilcoxon signed-rank tests. Results: CTV coverages were met for all IMPT plans, with 99% of CTVs receiving ≥ 100% of prescription doses. All organ at risk (OAR) objectives were met with IMPT3B and IMPT4B plans, while several rectum objectives were exceeded by IMPT2B plans. IMPT4B provided the lowest doses to OARs for the majority of analyzed outcomes, with significantly lower doses than IMPT2B +/− IMPT3B for bladder V30–V50 and mean dose; bowel V15–V45 and mean dose; sigmoid maximum dose; rectum V40–V72.1, maximum dose, and mean dose; femoral head V37–40 and maximum dose; bone V40 and mean dose; penile bulb mean dose; and skin maximum dose. Conclusion: This study is the first to compare proton beam arrangements when treating the prostate bed and pelvis. four-field plans provided better sparing of the bladder, bowel, and rectum than 2- and three-field plans. The data presented herein may help inform the future delivery of whole pelvis IMPT for prostate cancer.

Study designNarrative Summary Review for Navigation & Robotics Focus Issue.ObjectiveTo discuss the challenges and complications of S2-Alar-Iliac (S2AI) spinopelvic fixation using freehand techniques, and to introduce the utility of navigation & robotics to enhance patient safety.MethodsThis study involved search of literature using the PubMed database, including retrospective clinical studies, anatomic reports, and surgical reports. The intention was to find literature that discussed complications regarding screw malfunction from manual S2AI placement, anatomical complexity of the sacroiliac joint, and outcomes of S2AI procedures conducted with robotic guidance systems.ResultsThe sacroiliac joint presents numerous complexities that can lead to challenges in free-hand placement of the S2-alar-iliac screw. Anatomic considerations of the S2AI screw involve close proximity to vital neurovascular structures, including: superior gluteal vessels, external iliac vessels, pudendal vessels, superior gluteal nerves, sciatic nerve, sympathetic chain ganglia, and pudendal nerves. The complications associated with manual S2AI screw installation include screw misplacement, breach of cortical bone, and injury to neurovascular structures. Robotic techniques for establishing S2AI screws involve greater accuracy of screw placement and reduced complications.ConclusionsAccurate placement of S2AI screws is compromised by variation in pelvic anatomy and by a pathway that traverses dense cortical bone of the sacroiliac joint. Accurate placement of S2AI screws is important for patient safety regarding neurovascular structures, and for effective, stable fixation across the SI joint. Robotic navigation of S2AI fixation offers significant utility in improving the accuracy of screw placement and patient safety.

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Pelvic schwannomas are rare tumors that may occur either sporadically or in the context of schwannomatosis. We retrospectively reviewed the charts of patients harboring a pelvic schwannoma under conservative management or operated at our reference center between 2016 and 2023. All patients were operated by a multidisciplinary team, combining a vascular surgeon and a neurosurgeon. Twenty-four patients harboring 33 pelvic tumors were included in the cohort, including 12 patients with sporadic lesions, 2 patients with NF2-related schwannomatosis, and 10 patients with NF2-independent schwannomatosis. Multi-nodular tumors were more frequent in schwannomatosis compared to sporadic cases (p = 0.005). The mean age at diagnosis was 41 years old. Schwannomas were located on branches of the sciatic nerve (23/33, 70%), the femoral nerve (6/33, 18%), and the obturator nerve (4/33, 12%). Over the course of the study, 16 patients were operated, including 11 sporadic cases. The indication for surgery was pain (12/16, 75%) or tumor growth (4/16, 25%). Complete resection was achieved in 14 of 16 patients (87%). The mean post-operative follow-up was 37 months (range: 2–168 months). At last-follow-up, complete pain relief was achieved in all 12 patients with pre-operative pain. Post-operative morbidity included 3 long-term localized numbness and one MRC class 4 motor deficit in a multi-nodular tumor in a schwannomatosis patient. Despite its limited size, our series suggests that nerve-sparing resection of pelvic schwannomas offers satisfying rates of functional outcome both in sporadic and schwannomatosis cases, except for multi-nodular tumors. [ABSTRACT FROM AUTHOR]

This document provides a list of references for research articles in the field of veterinary medicine. The articles cover various topics, including the treatment of elbow disease in dogs, factors influencing thigh circumference measurement in dogs, and gait analysis in dogs with osteoarthritis. The document also includes information on measurement techniques, pain assessment scales, and statistical analysis software. It is a valuable resource for library patrons conducting research in veterinary medicine. [Extracted from the article]

Purposes Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re‐displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury. Methods A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma‐related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self‐Assessment Tool for Asians (OSTA) index, mechanism of injury, Young–Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction. Results The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young–Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p

Endometriosis is a disorder of the epithelium and/or endometrial-like stroma outside the endometrium and myometrium, usually with an associated inflammatory process. It mainly affects young women of reproductive age, the prevalence being estimated at approximately 10%. Due to the varied clinical symptoms marked by chronic pelvic pain, dysmenorrhea, infertility, dyspareunia, dysuria, endometriosis requires a complex treatment. Endometriosis is a major health problem with socioeconomic impact, which is why many gynecological societies have published different guidelines to assist clinicians in the diagnosis and treatment of endometriosis. The variety of available treatments combined with the complexity of this disease leads to significant discrepancies between recommendations. The most used is the ESHRE guidelines published in 2022, which represents an update of the ESHRE guidelines on endometriosis published in 2013 and 2005 regarding the diagnosis and treatment of endometriosis. The purpose of this review is to provide an overview of endometriosis treatment methods after comparing several widely used guidelines in endometriosis management.

One part of forensic anthropology involves investigating skeletal remains to identify corpses, and many of these remains were found incomplete, burned, broken, or destroyed, making investigation challenging. This study aims to use the pelvis and femur to identify the gender of skeletal remains. The pelvis and femur have previously been proven to be accurate indicators of a corpse's gender. The identification process is done through the measurement of the subpubic angle of the pelvis and the angle taken straight down from the top of the femur to the patella and then straight up. The two measurements were combined using the principal component analysis (PCA) method into two attributes on the x and y axes. These attributes were later used as data for the machine learning model design. The design process consisted of an Artificial Neutral Network (ANN) design model and Support Vector Machine (SVM) design model combined into a hybrid machine learning system. The ANN and SVM hybrid machine learning were tested with acquired data. The result of the test using the confusion matrix showed 83.33% accuracy, which is categorized as "good classification" based on Area Under the Curve (AUC).

Introduction: Albeit rare, open pelvic fractures are life threatening injuries associated with significant morbidity and mortality. Due to their rarity, there is paucity of data and literature on best management practices. An open pelvic fracture is one where there is a connection between the fracture site and either the skin, rectum, vagina, or genitourinary system. They commonly affect young individuals involved in high energy injuries. During resuscitation, prompt recognition and control of sepsis and stabilization of unstable fractures should precede definitive management. Materials and methods: We conducted a retrospective study of prospectively collected data between 2012 and 2022 for patients managed in two teaching hospitals in Kenya. All patients were followed up for at least 6 months. The Faringer classification was used to classify the soft tissue wounds and the Young and Burgess classification was used to classify the pelvic fractures. We investigated their functional outcomes using their ability to ambulate independently and the Merle d' Aubigne-Postel score. Results: Eight patients with an average age of 31 years were included. All were referrals. Three (37.5 %) developed sepsis but resolved. Four (50 %) needed a diverting stoma, which included 2 of the 3 patients who had developed sepsis. 5(62.5 %) needed an external fixator as part of definitive management. There were no mortalities. All achieved full independent ambulation; and all our patients achieved an average Merle d' Aubigne-Postel score of 17. Conclusion: Our study demonstrates that early sepsis control, appropriate fracture fixation and a multidisciplinary approach can yield satisfactory functional outcomes.

To assess outcomes of planned pre-operative uterine artery embolization (UAE) in patients with uterine fibroids at high risk for bleeding prior to hysterectomy or myomectomy. A retrospective review of 53 consecutive patients who underwent planned UAE followed by surgery from 2004 to 2019 was performed in a subset of patients deemed high risk for bleeding by the referring surgeon due to bulky fibroids and/or adhesions. Characteristics of the largest fibroid, total number of fibroids, embolic agents, estimated blood loss (EBL), complications, and other factors were collected. 53 patients (mean age = 41) had an elective UAE prior to a hysterectomy 24 (45%) or myomectomy 29 (55%). Median interval between UAE & surgery was 21.6 h (range 1.75 h-57 days). Of the myomectomies, 13 (45%) were open, 15 (52%) hysteroscopic and 1 laparoscopic. Mean number of fibroids/patient was 4.1 (SD 1.3), mean fibroid volume was 328 cm3 (range 11–741), and the mean fibroid diameter in longest dimension was 7.4 cm (range 3.2–15). Mean EBL was 90 (SD 99.5 mL). Three (10%) myomectomy patients required blood transfusion. All hysterectomies were via a laparotomy. Mean fibroid volume was 1699 cm3 (range 93–9099 cm3) with a mean maximum diameter of 16.2 cm (range 6.5–29.6) and an average of 2.4 (SD 1.7) fibroids. Mean EBL was 352 (SD 220 mL). Four (17%) hysterectomy patients required an intra- or post-operative blood transfusion. At a mean 1-year follow-up (range 1 month-14 years), 70% of UAE-myomectomy patients and 74% of UAE-hysterectomy patients reported symptom resolution. Three (6%) patients were readmitted: one for osteodiscitis, one wound dehiscence, and one for an infected retained fibroid after myomectomy. Planned pre-operative UAE resulted in intraoperative blood loss similar to "all-comer" myomectomy and hysterectomy patients in the literature. Further studies may elucidate which patients would be the best candidates for this staged treatment paradigm. • Patients with larger or adhered fibroids are at high risk of intraoperative bleeding during myomectomy or hysterectomy. Pre-operative uterine artery embolization is often used to mitigate intraoperative blood loss, but data is limited. • Retrospective analysis was performed of 53 patients who had an elective UAE prior to a hysterectomy (24 patients, 45%) or myomectomy (29 patients, 55%). • UAE-myomectomy patients had mean intraoperative EBL of 90 mL, with 3 of 29 (10%) requiring an intra- or post-operative blood transfusion. UAE-hysterectomy patients had mean intraoperative EBL of 352, with four (17%) requiring blood transfusion. • Planned uterine artery embolization prior to myomectomy or hysterectomy for uterine fibroids was safe and resulted in intraoperative blood loss similar to "all-comer" myomectomy and hysterectomy patients in the literature. [ABSTRACT FROM AUTHOR]

Study Design: Retrospective Cohort Study Objective: Spinal fusion, specifically constructs connected to pelvic bones, has been consistently reported as a predisposing factor to sacroiliac joint (SIJ) pain. The aim of this study is to compare SIJ outcomes in patients with constructs to the pelvis following instrumentation vs instrumentation plus fusion of the SIJ. Methods: Data of study subjects was extracted from a prospectively maintained database as well as retrospectively collected from records at a tertiary academic medical center in the United States between 2018 and 2020. Results: A cohort of 103 patients was divided into 2 groups: 65 in Group 1 [S2AI screw without fusion device] and 38 in Group 2 [S2AI screw with fusion device]. None of the patients in Group 2 developed postoperative SIJ pain compared to 44.6% in Group 1. Sacroiliac joint fusion occurred in all Group 2 but none of Group 1 patients. The postoperative Visual Analogue Scale (VAS) for lower extremity (LE) pain (.8 vs.5; P =.03) and postoperative Oswestry Disability Index (ODI) (18.7 vs 14.2; P <.01) were significantly higher in Group 1. The rate of distal junctional break, failure, and/or kyphosis (DJBFK) and time to DJBFK were not significantly different between the two groups, and the rate of DJBFK did not change in the presence of multiple covariates. Conclusion: The SIJs carry the heavy load of long lumbosacral fusion constructs extending to the pelvis. Simultaneous SIJ instrumentation and fusion decreases the risk of disability, prevents the development of postoperative SIJ pain, and may also protect the S2AI screw from loosening and failure. [ABSTRACT FROM AUTHOR]

This paper investigates the clinical efficacy of an automatic mobile trainer for gait training in stroke patients. Neuro-Developmental Treatment (NDT) is a rehabilitation method for stroke patients that enhances motor learning through repeated practice. Despite the proven effectiveness of therapist-assisted NDT, it is labor-intensive and demands health resources. Therefore, we developed automatic trainers based on NDT principles to perform gait training. This paper modifies the mobile trainer's intervention patterns to improve the subject's longitudinal gait symmetry, lateral pelvic displacement symmetry, and pelvic rotation. We first invited ten healthy subjects to test the modified trainer and then recruited 26 stroke patients to undergo the same gait training. Longitudinal symmetry, lateral symmetry, and pelvic rotation were assessed before, during, and after the intervention. Most subjects show improvements in longitudinal symmetry, lateral symmetry, and pelvic rotation after using the trainer. These results confirm the trainer's effectiveness of the modified intervention schemes in helping clinical gait rehabilitation for stroke patients. [ABSTRACT FROM AUTHOR]

Objective: To determine if a landmark-incorporated limb girth measurement in sound dogs, utilising the greater trochanter and the acromion process, would be both reliable and have a consistent ratio between pelvic limb (PL) and thoracic limb (TL) muscle measurements. Background: To establish a reliable and reproducible reference range for sound dogs. This reference range may help clinicians further evaluate dogs during lameness and musculoskeletal examinations. Evidentiary value: Prospective study of 115 sound dogs measured by a single observer. Methods:Examinations were performed by one observer, using a Gullick II tape measure for PL to TL ratio (PL:TL) measurements for 115 dogs. Bodyweight, breed, body condition score (BCS), and sex were recorded. Each limb was measured three times. The average PL:TL per dog was calculated. Further statistical analysis was used to calculate intra-observer variance and the correlation of limb girth to body weight, BCS, and sex, with significance set at P < 0.05. Results: The average PL:TL of the sample was 1.515 ± 0.049. Fifty-two dogs of the 115 cases (45%) had a PL:TL ratio of 1.500. PL:TL measurements were not related to dog weight, BCS, or sex. The intra-class correlation was reported to be 0.99. Conclusion: Our study suggests that a landmark-incorporated measurement in a weight-bearing position can be reproducible. Further investigation is required to determine if this measurement can be reproducible between multiple observers. Application: A landmark-incorporated limb girth measurement may guide clinicians in case progression and help pinpoint subclinical musculoskeletal disease in dogs.

Gastrointestinal (GI) symptoms are common in patients receiving radiotherapy, chemotherapy, and/or surgery for cancer in the pelvic organs. The aim of the present prospective cohort study was to report the efficacy of dietary intervention in patients with chronic GI sequelae to treatment of cancer in pelvic organs and insufficient symptomatic effect of medical treatment. Eighty-eight patients were offered specialist dietitian guidance. Gastrointestinal symptoms and quality of life were assessed before and after intervention by validated questionnaires. The main dietary interventions were low-fat diet (n = 44; 50%), modification of dietary fiber content (n = 19; 33%), dietary restrictions with a low-FODMAP (fermentable oligosaccharides, disaccharides, monosaccharides, and polyols) diet (n = 18; 20%), gluten-free diet (n = 1; 1%), and other dietary advice (n = 6; 7%). Compared to baseline, dietary intervention improved quality of life (EQ5D scale) (p < 0.01), bowel function for the last four weeks (p < 0.02), stool frequency (p < 0.03), constipation (p < 0.05), incomplete rectal emptying at defecation (p < 0.02), and performing usual activities (p < 0.0). In conclusion, this observational study using tailored dietary intervention showed that symptoms can be reduced and quality of life can be improved in patients with chronic GI sequelae following treatment of cancer in the pelvic organs not responding sufficiently to medical treatment. [ABSTRACT FROM AUTHOR]

Introduction: To investigate the application value of a three-dimensional (3D) printed pelvic model in laparoscopic radical resection of rectal cancer. Methods: Clinical data of patients undergoing laparoscopic radical rectal cancer surgery in The Second People's Hospital of Lianyungang City from May 2020 to April 2022 were selected. Patients were randomly divided into general imaging examination group (control group, n=25) and 3D printing group (observation group, n=25) by random number table method, and the perioperative situation of patients in the two groups was compared. Results: There was no significant difference in general data between the two groups (p>0.05). Operation time, intraoperative blood loss, intraoperative time to locate inferior mesenteric artery, intraoperative time to locate left colic artery, first postoperative exhaust time and length of hospital stay in the observation group were all lower than those in the control group (P < 0.05); There were no significant differences in the total number of lymph nodes and complications between the two groups (P > 0.05). Discussion: The application of 3D printed pelvic model in laparoscopic radical resection of rectal cancer is conducive to understanding pelvic structure and mesenteric vascular anatomy, reducing intraoperative bleeding and shortening operation time, which is worthy of further clinical application. [ABSTRACT FROM AUTHOR]

Purposes: Screw loosening is a common complication of iliosacral screw fixation, with subsequent loss of stability and fracture re‐displacement. This study aimed to investigate the incidence of and risk factors for screw loosening after iliosacral screw fixation for posterior pelvic ring injury. Methods: A total of 135 patients with posterior pelvic ring injuries who were treated with iliosacral screw fixation in our department between July 2015 and April 2021 were selected for this retrospective analysis. The possible risk factors for screw loosening were investigated using univariate and multivariate logistic regression analyses of patient demographics and trauma‐related and iatrogenic variables, including age, sex, body mass index, Osteoporosis Self‐Assessment Tool for Asians (OSTA) index, mechanism of injury, Young–Burgess classification, site of injury, type of injury, type of screw, mode of fixation, numbers of guidewire adjustments, accuracy of screw position, and quality of fracture reduction. Results: The incidence of screw loosening was 15.6% (n = 21). The mean duration for screw loosening was 3.2 ± 1.5 months after operation. Univariate analysis results showed that the Young–Burgess classification, type of injury, site of injury, type of screw, mode of fixation, and OSTA index might be related to screw loosening (p < 0.05). According to the multivariate logistic regression, vertical shear injuries (Odds ratios [OR] 9.80, 95% Confidence intervals [CI] [1.96–73.28], p = 0.008), type of injury (OR 0.25, 95% CI [0.13–0.79], p = 0.027), common screws (OR 6.94, 95% CI [1.53–31.40], p = 0.012), screws insertion only at the level of the first sacral segment (S1) (OR 8.79, 95% CI [1.18–65.46], p = 0.034), injury site located in the medial sacral foramina (OR 6.28, 95% CI [1.16–34.06], p = 0.033), and lower OSTA index [OR 0.41, 95% CI [0.24–0.71], p = 0.001] were significantly related to screw loosening. Conclusions: Vertical shear injuries, sacral fractures, injury site located in the medial sacral foramina, and lower OSTA index are significantly associated with the postoperative occurrence of screw loosening. Transiliac–transsacral screw fixation and screws insertion both at the level of the S1 and second sacral segment can prevent screw loosening. [ABSTRACT FROM AUTHOR]

The presentation of traumatic abdominopelvic injuries in sport can range from initially benign appearing to hemorrhagic shock. A high clinical suspicion for injury, knowledge of the red flags for emergent further evaluation, and familiarity with the initial stabilization procedures are necessary for sideline medical providers. The most important traumatic abdominopelvic topics are covered in this article. In addition, the authors outline the evaluation, management, and return-to-play considerations for the most common abdominopelvic injuries, including liver and splenic lacerations, renal contusions, rectus sheath hematomas, and several others. [ABSTRACT FROM AUTHOR]

The involvement of the genital tract of a hydatid cyst is rare and the occurrence in the uterus is an extreme rarity. The diagnosis of this localization is difficult because the clinical and radiological findings are often misleading and the diagnosis is often worn during surgery and after histopathological examination of the surgical specimen. We report the case of a patient who consulted for primary infertility, with a clinical finding as the only anomaly significantly large uterus, and imaging pointing strongly toward an ovarian multilocular cyst, and in which the discovery of hydatid cyst was accidental intraoperative with double localization uterine and omental. Radical treatment cannot be discussed in this young patient of 32 years and gravid 0. The removal of the cyst wall completely and excision of the mass epiploic seemed reasonable. The patient was placed under Mebendazol and is always under the supervision of a possible recurrence.

Urinary incontinence affects up to a quarter of the female population at an active age of over 40 years old. The rate increases by 40% for females over 60 years old. Medical rehabili-tation re-garding stress, urge or mixed geriatric urinary incontinence pathologies by using physical, non-invasive methods is poorly reported in literature, even though the obtained results are quantifiable, consistent, durable through continuous and periodic exercise. The objectives of rehabilitation of stress urinary incontinence, urge incontinence and mixed stress and urge uri-nary incontinence are the conscious toning of muscles of the pelvic floor, patient’s awareness of contractions thereof, and the improvement of these patients’ quality of life. Toning the muscles of the pelvic floor is essential in stress urinary incontinence whereas in urge incontinence it may increase urination control. Physical exercises increase the muscle tonus of the pubococ-cygeus muscles surrounding the vagina and the anus, and whose contraction may stop the evacuated quantity of urine, faeces and gases. The first-line treatment is the Kegel perineal reeducation, with a preventive and curative role in the treatment of urinary incontinence, also during the first and second stage of genital pro-lapse. Reeducation, supervision, guidance, re-laxation, and exercise are essential elements in the reduction of urinary incontinence or pro-lapse in nascent stages. In literature and in practice there are several approaches to pelvic reha-bilitation: some are minimally invasive, while others are non-invasive. In the current investi-gation, a group of elderly patients with stress, neurological or/and mixed urinary inconti-nence—which was linked to a mild genital prolapse in the female patients—were treated with four minimally invasive and non-invasive techniques. Associated comorbidities were type II diabetes (ADO treated) and a previous ischemic stroke in antecedents. Kegel exercises will be supplemented by transcutaneous electrical neurostimulation. Electrical neurostimulation also brings non painful electrical stimulation thus producing the contraction of the external sphinc-ter muscle of urethra and the levator ani muscle inducing the inhibition of the detrusor mus-cle and of the contraction of the urinary bladder. After a 3-4 week training, subjective improve-ments and the spacing out of urinations to 3-4 hours are registered. The continuation of treat-ment up to 2 months (60 days) additionaly improves patients’ functional status, thus substanti-ating and stabilizing the obtained results over time. Positive outcomes were attained, as the pa-tient was able to effectively complete the pelvic rehabilitation course of action. Urinary losses could be completely eliminated and the number of nighttime bath-room visits was lowered to the recommended physiological threshold (one awakening per night).Keywords: prepuberty, posture abnormalities, scoliosis, somatoscopy, physiotherapeutic assessment

Transabdominal ultrasound (TAUS) is usually the first approach for diagnosis of reproductive tract complaints in all adolescents. However, there are instances when transrectal ultrasound (TRUS) is more feasible. Although TRUS is considered more invasive and distressing, evidence-based data are lacking. The aim of this study was to evaluate the level of anxiety in adolescents subjected to TAUS and TRUS and in their caregivers. In this cross-sectional study, data were prospectively gathered using 2 instruments: the adult or child version of the State and Trait Anxiety Inventory (STAI or STAIC) and a self-developed survey. TAUS and TRUS are connected with high-level anxiety in patients and moderate anxiety in caregivers, as measured by the STAI/STAIC questionnaires. TRUS-related anxiety, fear, discomfort, and pain in adolescents are significantly higher compared with TAUS. The TRUS-related anxiety of caregivers, as well as the parent-estimated fear, discomfort, and pain of adolescents, is significantly higher compared with TAUS. Anticipated pain connected to TRUS is significantly higher than the post-exam, actually experienced pain. Pain and shame are the main reasons for adolescent anxiety connected with TRUS, whereas shame and unknown experience contribute to TAUS-related anxiety. Given the high level of anxiety associated with both exams, additional support should be provided to patients scheduled for any pelvic ultrasound exam. Given the even higher level of adolescent anxiety related to TRUS, specialists should be encouraged to train in TAUS and make efforts to begin with this approach. Because increased caregiver anxiety could adversely affect a child's reactions, anxiety-reducing interventions should be oriented toward the caregivers as well as the patients. [ABSTRACT FROM AUTHOR]

Longitudinal sacral fractures are usually a matter of controversy regarding decision-making for reduction, fixation, and approach. Percutaneous and minimally invasive techniques present perioperative difficulties, but with fewer postoperative complications compared to open techniques. The objective of this study was to compare the functional as well as radiological outcomes of the Transiliac Internal fixator (TIFI) versus Iliosacral screw (ISS) fixation of sacral fractures applied percutaneously in a minimally invasive technique. A Prospective comparative cohort study was conducted in a level 1 trauma center in a university hospital. The study included 42 patients with complete sacral fractures, 21 patients have been allocated to each group (TIFI group & ISS group). The clinical, functional, as well as radiological data, were collected and analyzed for the 2 groups. The mean age was 32 (18 -54 years), and the mean follow-up was 14 (12 -20 months). There was a statistically significant difference in favor of the TIFI group regarding a shorter operative time (P = 0.04) as well as less fluoroscopy time (P = 0.01) whereas there was less blood loss in the ISS group (P = 0.01). Both the mean Matta's radiological score, the mean Majeed score as well as the pelvic outcome score were comparable between the 2 groups with no statistically significant difference. This study suggests that both TIFI and ISS through a minimally invasive technique represent valid methods for sacral fracture fixation with a shorter operative time, less radiation exposure in TIFI and less blood loss in the ISS. However, the functional, as well as radiological outcomes, were comparable between the 2 groups. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study is to determine if there is a difference in outcomes for patients with blunt and penetrating vascular injuries of the pelvis. Methods: Data were abstracted from the Trauma Quality Improvement Program database from 2011 to 2015. Patients >18 years with hypogastric, iliac, uterine, or ovarian arterial or venous injuries were included. Individuals with an AIS head or chest score >3 were excluded. Results: Of the 2559 patients included, the mean age was 43 years (±19), 75.25% were male, and 32.6% had a comorbidity. 64.9% presented with blunt injury (mean ISS of 23 (±12)). 74.9% experienced a complication. The median hospital length of stay (LOS) and ICU LOS were 10 days and 4 days, respectively. 6.7% had an adverse discharge. Mortality occurred in 8.3%. On bivariate analysis, patients who sustained blunt trauma were older (51 vs 31 years), female (32.7% vs 10.1%), had a higher ISS (25.71 vs 17.65), and had a longer hospital LOS (16.65 vs 13.88). Patients with penetrating trauma had an increased chance of complications (78.4% vs 73.0%) and mortality (10.7% vs 7.0%). Multivariate analysis revealed in patients with blunt injuries have more complications (OR: 1.950 CI: 0.886-4.291 P =.097), a lower ISS (OR: 0.919, CI: 0.908-0.930, P <.001, were more likely to have an adverse discharge (OR: 2.05, CI: 1.62-2.60, P =.000), and had a higher risk of mortality (OR: 4.08 CI: 2.78-6.41 P <.000). Conclusion: Patients with blunt pelvic vessel injuries are at risk for an increased number of complications and have a higher risk of mortality. Those who survive are more likely to have an adverse discharge. [ABSTRACT FROM AUTHOR]